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Original Research Investigating the Association of Criminal Behavior With Childhood Trauma, Impulsivity, and Dominant Temperaments in Bipolar I Disorder
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Objective: To examine impulsivity, dominant temperaments, and childhood trauma in bipolar I disorder patients who have committed crimes by comparing them to bipolar I patients with no criminal history and healthy controls.
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Methods: A total of 144 subjects in 3 groups (62 bipolar patients with a criminal history, 40 non-criminal bipolar patients, and 42 controls) participated in this cross-sectional study. All participants completed the Childhood Trauma Questionnaire (CTQ), the Barratt Impulsiveness Scale (BIS-11), and the TEMPS-A (Temperament Assessment of Memphis, Pisa, Paris, San Diego Autoquestionnaire). Subjects were enrolled in the study between April 1, 2019, and March 1, 2020.
= .045) among bipolar criminal history patients than the other 2 groups. Of quantitative variables, physical abuse and emotional abuse subscales and CTQ total score were significantly higher in both patient groups compared to healthy controls (
< .001 for all scores). For dominant temperament, the hyperthymic temperament scores of the bipolar criminal history group were higher than that of the control group (
Conclusions: It was found that patients with bipolar I disorder experienced more childhood traumas, and the bipolar group with a criminal history and those who were admitted to prison had suffered more physical abuse. Hyperthymic temperament was dominant in bipolar I patients involved in crime. Taking into account the temperaments of bipolar I disorder in treatment plans and providing psychosocial support to these patients can help prevent violent behavior and the possibility of crime.
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To cite: Özsoy F, Taşcı G, Atmaca M. Investigating the association of criminal behavior with childhood traumas, impulsivity, and dominant temperaments in bipolar I disorder.
*Corresponding author: Filiz Özsoy, MD, Clinic of Psychiatry, Yeni District, Tokat State Hospital, 60100 Center, Tokat, Turkey ([email protected]).
Psychiatric illness has been suggested for many years to be associated with violent behavior and crime. It has even been reported that the risk of violent behavior increases in people with serious psychiatric illnesses.
Violent behavior is not increased in every psychiatric illness, but is more common especially in psychiatric illnesses such as bipolar disorder and schizophrenia.
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In other words, compared to the general population, people with psychiatric illness are not more dangerous, but there is a dangerous subgroup in psychiatric illness.
On psychiatric illness and crime are limited. In most of the available studies, rates of psychiatric illness have been investigated among people who have committed crimes. Study
With patients with bipolar disorder found that the probability of violent behavior increased 3 times compared to the population without psychiatric illness. This rate was reported to be 20 times higher when substance abuse was involved.
Mood disorders, substance abuse, and personality disorders have been found to be linked to violence. In addition, childhood traumas were reported to be risk factors for violent behavior and commitment of criminal acts by psychiatric patients.
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It is defined as the behaviors that can be avoided, excluding accidents, by those who care for the children that can hinder the physical and psychosocial development of the child. Child abuse is a multifaceted phenomenon and is divided into 5 groups: emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect.
Childhood traumas have been linked to the development of many psychiatric diseases such as depressive disorder, bipolar disorder, psychotic disorder, low self-esteem and suicidal thoughts, and personality pathologies.
In addition, childhood traumas were also reported to be associated with pleasure and excitement seeking, attention deficit, and impulsive behavior such as sudden decision making, anger control problems, violence, and criminal tendency.
It is defined as an action or behavior that is done suddenly, quickly, without thinking in the end, and without making a plan. Although it is basically defined as a personality dimension, impulsivity is a complex concept with both behavioral and cognitive aspects.
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However, personality is formed by the combination of temperament and character. Temperament includes structural properties that are genetically transmitted and undergo little change during life. Character is a result of adaptation to changes through the effects of environmental factors, family, and education. Akiskal and Mallya
Studies examining the relationship between psychiatric illness and violent behavior in the literature are limited. In these studies,
On criminal behavior and psychiatric illness, parameters such as the frequency of criminal behavior and characteristics of the offense were examined in patients with schizophrenia. Studies
Dealing with the criminal behavior of patients with bipolar disorder are also very limited. Furthermore, to our knowledge, there have been no studies examining the temperaments, childhood trauma, and impulsivity levels of bipolar disorder patients who have had criminal involvement. The aim of the present study was to investigate the dominant temperaments, childhood traumas, and levels of impulsivity of patients with bipolar I disorder with a criminal history by comparing them with bipolar I patients without criminal involvement and with strong controls.
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This cross-sectional study used standardized scales of childhood trauma history, impulsivity and temperament to compare 2 samples of patients with bipolar I disorder admitted to an inpatient psychiatric unit during the manic phase of the illness (1 group with criminal records, 1 without any criminal history) and a comparison group of patients without psychiatric or alcohol/substance abuse disorders. Subjects were enrolled in the study between April 1, 2019, and March 1, 2020. The study was approved by the Local Non-Invasive Ethical Board of Tokat Gaziosmanpaşa University and the Management of -Provincial Health and was implemented according to the Declaration of Helsinki.
All participants were informed about the study, and signed consent was obtained from those willing to participate. The study consisted of 3 groups. The first group included inpatients with a diagnosis of bipolar I disorder based on
Criteria who committed crimes and were kept under observation or protected in the criminal psychiatry unit of Elazığ Fethi Sekin City Hospital, while the second group included patients with bipolar I disorder who were not involved in any criminal behavior . The third group included healthy controls with matching demographic characteristics such as age, gender and level of education without any diagnosis of psychiatric disorders.
Subjects who were willing to participate, literate, and able to provide written consent were included in the study. Subjects with poor general health status, chronic liver disease, chronic renal failure, chronic heart disease, mental impairment, alcohol/substance abuse, or who did not want to participate were excluded. Patients with bipolar disorder and depressive episodes were not included in the study. The healthy control group consisted of individuals who applied to the outpatient clinic of psychiatry for a general examination, job application, or military examination and consultation; had no psychiatric illness or alcohol/substance use
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For this study, 84 bipolar I patients who committed crimes (bipolar group with criminal history) and 55 who were not involved in criminal behavior (bipolar non-criminal group) were interviewed. Fifteen people in the criminal history bipolar group and 10 in the non-criminal bipolar group refused to participate in the study. Therefore, 62 bipolar patients with a criminal history and 40 non-criminal bipolar patients met the inclusion criteria. In addition, 42 healthy controls with matching sociodemographic characteristics were also included.
All participants signed a consent form and completed the sociodemographic data form. Then, all participants completed the study scales. In the patient groups, the scales were administered about a week after admission to the hospital in the examination room of the psychiatry service after the acute manic episodes had partially subsided. In the healthy control group, the scales were completed in the psychometric test room of the psychiatry outpatient clinic after psychiatric and psychometric examinations.
All participants completed the Childhood Trauma Questionnaire (CTQ), the Barratt Impulsiveness Scale (BIS-11), and the TEMPS-A temperament scale (Memphis Temperament Assessment, Pisa, Paris, San Diego Autoquestionnaire). Patients with bipolar I disorder also completed the Young Mania Rating Scale (YMRS).
The sociodemographic data form was prepared by the investigators based on the objectives of the study. This form included questions on demographic variables such as age, place of residence, marital status, level of education, and economic status, as well as questions on clinical and criminal information such as duration of psychiatric illness, presence of psychiatric illness in the family requiring treatment, alcohol or tobacco use, and history of incarceration.
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It is a retrospective self-report scale that assesses neglect and trauma experienced during childhood and adolescence. In the present study, the 28-question form of the scale was used. The scale has 5 subscales: physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect.
The BIS-11 is a 30-item self-report scale used to assess impulsivity. It consists of attentional (attention and cognitive instability), motor (motor and perseverance), and non-planning (self-control and cognitive complexity) components. The BIS-11 was developed by Patton et al
To assess variations in temperament. It is a self-report scale consisting of 100 questions to determine depressive, cyclothymic, hyperthymic, irritable and anxious temperaments. Depressive temperament is assessed with 18 items, cyclothymic temperament with 19 items, hyperthymic temperament with 20 items, irritable temperament with 18 items, and anxious temperament with 24 items. The TEMPS-A scale was adapted for Turkish by Vahip et al.
Was developed to assess the intensity and change of manic status and is completed by
Mean Change From Baseline In Young Mania Rating Scale (ymrs) Total…
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